Availability of integrated family planning services in HIV care and support sites in sub-Saharan Africa: a secondary analysis of national health facility surveys

Abstract

Background Integrating family planning (FP) with HIV care and treatment programs is a strategy to expand FP service delivery and prevent unintended pregnancies among women living with HIV. However, little is known about the extent to which FP services are available in health facilities providing HIV services across sub-Saharan Africa. In this study, we assessed the availability of integrated FP services and the associated factors in HIV care and support sites across sub-Saharan Africa. Methods We conducted a secondary analysis of nationally representative facility-level data from Service Availability and Readiness Assessments (SARA) and Service Provision Assessments (SPA) conducted in 10 sub-Saharan African countries between 2012 and 2015. We used six indicators that reflect the structure and process of care essential for FP service delivery in HIV care and support facilities to define the outcome of interest - onsite availability of integrated FP services. Multivariate logistic regression was used to explore facility-level characteristics associated with the outcome. Results Among the 3161 health facilities offering HIV care and support services, most reported also offering FP services at the same location. The availability of three FP methods was higher than the availability of FP guidelines and trained staff. Onsite availability of integrated FP services ranged from 10 to 61%. Results of multivariate logistic regression indicated that the odds of having onsite integrated FP services available was higher in HIV care and support sites that were operated by the government, classified as a tertiary level care facility, and provided services for PMTCT, antenatal care and basic surgery. Conclusions Our findings indicate critical shortcomings in the preparedness of HIV care and support sites to deliver onsite integrated FP services. Renewed efforts are needed to address these supply-side barriers and ensure that integrated FP and HIV services meet the unique needs of HIV clients. Electronic supplementary material The online version of this article (10.1186/s12978-019-0713-x) contains supplementary material, which is available to authorized users.

<p>Integrating HIV and Family Planning Services: The Pros and Cons</p>

“…14 The health facilities did perform effective integrated services with competent staff. 10 Moreover, additional resources such as fiscal resources and infrastructure that allow for a quality service to be offered, should be mobilised at the health facility level. 14 Securing additional fiscal resources is an essential prerequisite to ensure the availability of HIV drugs and contraceptives, training of healthcare workers in both HIV and family planning services, and to ensure the sustainability of the integrated service.…”

“…3 In sub-Saharan Africa, the availability of integrated family planning services at health facilities ranged from 10-61%. 10 Integration of HIV and family planning services, like all other integrated services, has its advantages and disadvantages. It is known that an integrated service can minimize the missed opportunities and allow health workers to provide family planning services and HIV services simultaneously.…”

Reproductive intentions and corresponding use of safer conception methods and contraception among Ugandan HIV clients in serodiscordant relationships

“…Across sub-Saharan Africa, including Uganda, reproductive health and family planning services have been integrated into HIV care [ 1 ]. In Uganda, and throughout the region, family planning services historically and currently focus exclusively on preventing unplanned pregnancies.…”

Reducing the unmet needs of family planning among women of reproductive age in Northern Region of Ghana

“…In sub saharan countries, the service was integrated into primary health care delivery system and this could have been responsible for increased accessibility and acceptability even in the rural areas (Ahmed et al, 2019). Additional cost is minimal and the services are more sustainable over a long period of time making it cost effective (Kanyangarara, Sakyi, & Laar, 2019). Vol.…”